Review Articles Disability in

Maher S. Al-Jadid, JBPM&R, FAFRM (H).

isability is a multidimensional and complex ABSTRACT Dconcept and it is substantially limits a major life activity of a human. It may affect the persons and ,his family. This will negatively influence the person اإلعاقة مصطلح يشير إلى ظاهرة معقدة ومؤثرة متعددة األبعاد family, and the whole society if the system does not تعيق أنشطة احلياة الرئيسة بشكل جوهري ومقدرة الشخص 1 support them. Almost each person will be temporarily على التكيف واإلندماج في املجتمع. تشير تقارير منظمة الصحة 15% or permanently impaired at some point in life, and those who survive will experience many limitations in العاملية بأن من سكان العالم ميارسون حياتهم مع أنواع 2-4% function and participation in the society. As per the محددة من اإلعاقة و واجهوا صعوبات جوهرية في العمل. Labor and Workman Law of Saudi Arabia, a “persons في اململكة العربية السعودية هنالك القليل من األبحاث عن with disability” is defined as “any person whose capacity أسباب حدوث وانتشار اإلعاقة والعديد منها موجه إلى األطفال to achieve and continue a suitable job has actually املعاقيني. كما أن هنالك العديد من املعوقات في إجراء أبحاث ”.diminished as a result of a physical or mental infirmity اإلعاقة في السعودية. نستعرض في هذا التقرير الوضع احلالي Most extended families have a disabled person, and لإلعاقة وأبحاث اإلعاقة والتأهيل في اململكة العربية السعودية the non-disabled persons take the responsibility and care for their lives.1-3 Many countries face the moral من األدبيات املنشورة. and political issue of how best to include and support Disability is a complex, influential, dynamic, multidimensional challenge, and it can substantially people with disabilities. This issue will become more acute as the demographics of societies change and more limit major life activities of human beings and their 4 ability to integrate/reintegrate into society. According people live in their old age. In developed countries, to the World Health Organization reports almost persons with disabilities have no equal access in the 15% of the world’s population lives with certain types society or even in other services such as health care, of disability, of whom 2-4% experience substantial education, employment opportunities, and sometimes difficulties in functioning. In Saudi Arabia, very limited they were disregarded from everyday life activities. research has been conducted on the prevalence and Despite the magnitude of the issue, awareness of and incidence of disability, and most of this is on disabled scientific information on disability issues are deficient. children. There are several difficulties associated with In addition, there was no agreement concerning its conducting research on disability related issues in definitions, internationally comparable information, Saudi Arabia. Here, we review the current situation distribution, and trends of disability. The reasons might of disability, disability research, and rehabilitation in be financial, social isolation and/or accessibility. There Saudi Arabia from the published literature. is a limited number of published literatures addressing the policies and responses concerning people with Saudi Med J 2013; Vol. 34 (5): 453-460 disabilities.5 Persons with disability may require a continuous From the Rehabilitation Department, Prince Sultan Military health care support, regular medical check up, home Medical City, , Kingdom of Saudi Arabia. based support and other supportive services including Received 17th October 2012. Accepted 17th March 2013. equipments provision, which make the care programs very costly. Some patients need to be relocated in Address correspondence and reprint request to: Dr. Maher Al-Jadid, homes due to their conditions and lack of proper Rehabilitation Medicine Department, Prince Sultan Military Medical home care. The management of people with disability City, PO Box 14126, Riyadh 11424, Kingdom of Saudi Arabia. Tel. +966 (1) 4777714 Ext. 25301. Fax. +966 (1) 4722400. may needs specialized medical, social, psychological, 6-8 E-mail: [email protected] vocational, and other rehabilitative care. The love and support of family plays an important role in taking care

www.smj.org.sa Saudi Med J 2013; Vol. 34 (5) 453 Disability in Saudi Arabia … Al-Jadid of them. The cost of preventive efforts is significantly significant complications was estimated at 2.2% (92 lesser than the management of expected complication; million people).5 The analysis of the Global Burden of thus cost-effectiveness favors the prevention approach.9 Disease estimates that 15.3% of the world population The earlier the medical/rehabilitative care are delivered, (978 million people of the estimated 6.4 billion)20 the more the chance of reducing its effect of disability had “moderate or severe disability”, while 2.9% and it reduces the chance of expected complication, and or approximately 185 million experienced “severe the more the quality of life of the person will improve.5 disability”.5 Country-reported disability prevalence. Several Disability in Islam. Islam, as a divine religion is countries have been collecting prevalence data on against discrimination whether based on any racial, disability through consensus and surveys, with many gender, color, or ability. having moved from an “impairment” approach to In the Holy Book of Qur’an, Allah the Almighty a “difficulties in functioning” approach. Estimated has assured us (translation of meanings) in Surah prevalence rates were vary widely across within Al-Inshirah that “with every hardship there is relief,” countries.10-12 Most developing countries reported that (94:5) and in Surah Al-Baqarah that “Allah burdens not disability prevalence rates were below those reported in a person beyond his scope” (2:286). In Surah Yusuf the many developed countries, because they collect data on Qur’an states, “truly no one despairs of Allah’s soothing a narrow set of impairments, which yield lower disability mercy, except those who disbelieve” (12:87). prevalence estimates.5 However, many countries are Human’s life is a full record of hardships, obstacles, using International Classification of Functioning, struggle and tribulations from birth to death. In this Disability and Health (ICF) framework and related sense, Allah says: “We create man from a drop of thickened questions in their national disability surveys and fluid to test him” (Al-Insaan:2). It is also an important consensus.13-17 In Kingdom of Saudi Arabia (KSA), very thing that Almighty Allah, when depriving a person of limited research has been conducted on the prevalence certain ability or gift, compensates him/her for it, by and incidence of disability, and most of them were on bestowing upon him/her other gifts by which he/she disabled children. outshines on others. It is confirmed that people who Global estimates of disability prevalence. Several are deprived of sight, have best insight and have very definitions exist worldwide with no consensus ona sensitive ears and can hear very low sense of sounds and standard definition being established. According to touch. People with physical disability possess excellent the World Health Organization (WHO), disabilities memory capabilities as compensated. are an umbrella term, covering impairments, activity During the pre-Islamic period, the Arab Society has limitations, and participation restrictions. Impairment used to disregard the disability of people mainly social is a problem in body function or structure; an activity isolation and prevention to lead normal lives. They may limitation is a struggle encountered by person in have a reason of ridicules. Also, people of Madinah used executing a task or action; while a participation to prevent the limping and blind people from sharing restriction is a problem experienced by an individual in food with them, because they are deemed and repulsive. the involvement of life situations. Disability is a complex On this, Allah the Exalted revealed what it means in the phenomenon, reflecting an interaction between features holy Quran stated that, no blame is there upon the blind of a person’s body and features of the society in which nor any blame upon the limping nor any blame upon 18 he/she lives. the sick nor on yourselves if you eat from your houses, The World Health Survey (2004) conducted by or the houses of your fathers, or the houses of your WHO on 59 countries who experienced significant mothers, or the houses of your brothers, or the houses functioning difficulties reported that the average of your sisters, or the houses of your fathers’ brothers, or prevalence of disability in adult population was the houses of your fathers’ sisters, or the houses of your 15.6% (4.2 billion people), ranging from 11.8% in mothers’ brothers, or the houses of your mothers’ sisters, higher income countries to 18% in lower income or (from that) whereof you hold the keys, or (from the 5,19 countries. The prevalence level for adults with very house) of a friend. No sin shall it be for you whether you eat together or apart. But when you enter houses, salute one another with a greeting from Allah, blessed Disclosure. The author has no conflict of interests, and and sweet. Thus Allah make it clear His revelations for the work was not supported or funded by any drug you that happly you may understand”(An-Nur 24:61). company. There are several companions (Sahaba’a) with special needs for Prophet Mohammed (Peace Be Upon Him)

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Table 1 - Population, number of , and available beds in the who has participated in announcing Islam (Dawa’a) 22 and even joining in battlefield. Their work was very Kingdom of Saudi Arabia. recognized by him and he looked at them same like Saudi Arabia Numbers other Sahaba’s. Population 28,376,355 Disability in KSA. Saudi Arabia is the largest country Number of hospitals 415 in the occupying approximately four-fifth Number of beds 58,696 of the Arabian Peninsula and has a population of Hospitals affiliated to MOH 251 approximately 28,376,355.20 Most (65%) of the Saudi Number of beds in hospitals affiliated to MOH 34,450* population is concentrated in 3 main administrative MOH - Ministry of Health, *10,948 beds in other governmental sectors region namely, Riyadh, Makkah and Eastern Province. In 2011, KSA has a significant increase in the healthcare and inadequate research on initial identification of budget from SAR30 billion in 2008 to SAR68.7 billion disability.26,28-30 Further, there is no standard outcome in 2011 (Table 1).21 measure used to assess or identify the degree of disability. Disability is one of the most imperative social and Poor data collection procedures are also the major economic medical issues in KSA. Compared to the problem in Saudi disability related research. Nationwide developed countries, the incidence and prevalence of studies reported that the incidence of disability in cities impairment, disability and their socio-demographic is higher than in rural areas28,29 and this is in contrast properties are unavailable, due to lack of appropriate to the fact those medical services and health education studies in the specified area.22 Despite the growing programs are well in large cities than in rural areas. awareness, limited research has been carried out to Essentially, there is no specialized institute for dealing determine the pattern of disabilities in KSA.23 with or collecting data such as those in the USA where Hurdles in disability research in KSA. Depending specialized studies offer a good basis for understanding upon the definition used, it is estimated that 3.73% of disability statistics. the population has functional disabilities, which limit Leading causes of disability. Road traffic accidents, their independence.24 But, the countrywide data from stroke, cerebral palsy, head and spinal cord injuries, demographic survey (door to door national census) infection and inflammation are the major causes of indicates that approximately 135,000 or nearly 0.8% mortality, hospitalization, and chronic disability in of the total Saudi population has disability. These KSA.20,21 Furthermore, the incidence of consanguineous differences are mainly due to definition and under marriages is too high. A study reported that the overall reporting of the burden. The main causes of disabilities prevalence of consanguinity was 56%. The first-degree are cerebral palsy and developmental delay followed cousin consanguinity was 33.6% being more frequent by road traffic accident. The main care gaps are low than all other relations (22.4%). As a result, the risk access to poor families, low service coverage (no long of disabilities associated with genetic causes is also term care, no palliative), and low quality of services in significant.31 public agencies. In order to address disability related Psychological impact of disability. Psychological issues, it is imperative to make better use of the existing investigation of the past decades has addressed some information on the prevalence of disability. Also, it is of the difficulties encountered by the disabilities in essential to address the gaps in current knowledge on society.32 Decades ago it was thought that the number the nature of disability. of persons with disabilities in KSA was quite low. This is There are many difficulties associated with because some families tend to leave them behind closed conducting research on disability related issues in doors. People with disability were ignored to attend KSA. Some cultural issues were people feel ashamed of the social gatherings and even relatives can hardly see having disable relative and tend to avoid participation the disabled people. They may be exposed to society in research.25 Their opinions were based on a simple only when sick and during a visit. They are notion of disability that includes helplessness, continuing occasionally a stigma for the families. Further, disabled dependence, being home-bound, low quality of life, girls were hidden away in home as they could be a reason and deficiency of productivity.24 The important barrier for his/her sisters not getting married as people will is the lack of epidemiological research on the general avoid approaching the family. The term disability is not population where most disability research were carried acceptable by the society nowadays and most agencies out in Saudi Arabia on disabled children.6,26,27 Another avoid this term, rather they use the term “people barrier is the limited nature and extent of information with special needs.” Some people avoid this term as a about disability, studies were conducted as surveys, protective strategy for the person and/or family. Denial

www.smj.org.sa Saudi Med J 2013; Vol. 34 (5) 455 Disability in Saudi Arabia … Al-Jadid could be the whole cause of avoiding this term. It was care and required vaccination during pregnancy.29 The reported that the anxiety and depression rates were prevalence of neurological disorders in Saudi children higher in mothers with female disable children.32 It used were 45,682. Of them, 313 had chronic neurologic to be thought that all types of disabilities is hereditary disorder representing a prevalence rate of 68.5 per even if it was acquired during adulthood. The problem 10,000 children, which is the highest among all chronic started when they are walking and in a wheel chair diseases in children. Mental retardation is the most drooling in public. Adjustment period to acquired common neurologic disorders with a prevalence rate disability usually takes time during the sub-acute of 26.3/10,000 and cerebral palsy was 23.4/10,000. phase (for the acquired disability) as many are hoping It is also found that the major neurologic disorders to get rehabilitated, but as soon as a person accept the were the most common pediatric chronic disorders in disability with the tendency of being more strict to KSA.33 A cross-sectional study reported that trauma as religion in both gender. The concept of rehabilitation in an etiology of disability was found to be more common most people in KSA is being interpreted in the form of than non-traumatic incidents among males and middle therapeutic “massage” only. age patients (16-45 years). Traumatic accidents mostly The risk of suicide attempts, and suicide ideation and result in quadriplegia (72.8%).34 suicide thought is lesser in acquired physical disability The lack of common measure, definition of such as spinal cord injury (SCI) in KSA. Person with disability and the limited epidemiological research in SCI has committed suicide due to their paraplegia KSA was difficult to assess the burden although itis or quadriplegia is rare in KSA. On the other hand, commonly acknowledged that burden is generally high following rehabilitation many persons with paraplegia due to social and environmental factors. According or quadriplegia completed their higher education in to WHO, the number of those who suffer physical, KSA and tend to be more attached to religion than in sensory, intellectual or mental disability to be 15% of the pre-morbid status. Extended families is still being the population, although individual countries have practiced and it is part of Islamic tradition. Because of given numbers that vary from 4-20%. Based on the this reason, other patients tend to adjust quickly after the disability. The only disadvantage is the overprotection, findings of WHO, 15% of the disability rate in 2012, which makes the person more dependent on others even it is estimated that 4,070,546 people in KSA require after being rehabilitated and achieved self-independence. rehabilitation services. If we apply the 3.73% disability In fact, patients with difficulty in ambulation wanted rate from KSA surveys, it is estimated that 1,012,209 the whole therapy to help them walk and will not people suffer some form of disability in KSA. contribute a lot of attention to self-care training. They Policies and practices on disability in KSA. Kingdom would argue that their beloved one would take care for of Saudi Arabia is based on the Islamic Sharia, which them. Sometimes a recruited caregiver will be vacated to emphasizes human rights. Persons with disabilities have 35 provide the activities of daily living even if the patient the right to live with dignity and benefit of welfare. A is living with the family. Workforce in this regard is not sound living and the ability to engage into all sectors expensive and affordable. of society assured through providing rehabilitation and Important existing research on disability in KSA. In healthcare services for them.36 On the other hand, there KSA, there is a lacunae in research related to prevalence were limited reliable information on disabilities such and incidence of disability and most disability research as numbers, types of disabilities, amputee population, were on disabled children.28,29 A study from Qaseem or geographical distribution in annual report of reported that the incidence of physical disability Ministry of Health (MOH). Most of the specialized (1.7%) was higher in children as compared to mental organizations become more sensitive in reporting the retardation (1.4%).30 A national survey was conducted statistics on disabled persons due to security reasons, among 60,630 children reported that 3,838 (6.33%) and it was noticed that the reported data are vastly children were reported having a disability. The survey underestimated, due to poor reporting.35 also reported that the highest ratio of handicapped Institutions for persons with disabilities are largely children was in Jazan region (9.9%) and Riyadh had available in urban than rural areas, with an uneven the lowest (4.36%). The most common disability was distribution of facilities irrelative to persons with physical disability (3%) followed by learning disability disabilities distribution. Many disabled persons suffer (1.8%).29 Further, the highest proportion of disability from marginalization due to some reasons such as lack was found among children of disabled parents, later-in- of understanding of the nature of the disability and life pregnancies and mothers had not received medical the fear of dealing with it, being ashamed from the

456 Saudi Med J 2013; Vol. 34 (5) www.smj.org.sa Disability in Saudi Arabia … Al-Jadid involvement with their community, poverty, living deformity and/or fitting with braces to help in walking. in remote places, lack of understanding of the ways Others received some sort of physiotherapy, but that was of dealing with such cases, and ignorance of the role limited to patients living in major cities.39 In early 1970’s, assigned to health facilities.35 the government launched some prosthesis and orthotic Medical services and rehabilitation. Health services centers in some of the MOH hospitals, but that focused in KSA are provided mainly by the government through only on braces or caliper fitting. In the beginning of the the Ministry of Health (MOH). In 2011, the total 1980’s, the Ministry of Defense and Aviation (MODA) number of hospitals in KSA reached up to 415 hospital commissioned many medical rehabilitation centers with 58,696 beds and 5 additional hospitals were within the Military Hospitals. Some private hospitals added during the year. On this data, 251 were affiliated also allocated some rehabilitation beds for people who by the MOH in various regions (34,450 beds including sustained work related disability and were insured by 10,948 beds in other governmental sectors).37-39 Most general organization for social insurance. Only in of the secondary healthcare services were provided by the beginning of the 21st century when real medical the general hospitals.37-39 The require for rehabilitation rehabilitation centers were opened in few of the MOH services is imperative for people who have sustained hospitals. In addition, there have been some private severe injury often due to trauma, stroke, infection, for non-profit centers, which opened, including Sultan tumor, , or progressive diseases in order to Bin Abdulaziz Humanitarian City.39 Presently, there improve their quality of life. However, the require for are many rehabilitation hospitals/ centers, mainly in rehabilitation crosses all age groups, although the type, large cities, such as Rehabilitation Unit of Prince Sultan level, and goals of rehabilitation differ. People with Military Medical City of Riyadh (Formerly known as severe impairments, often elder people, have different Riyadh Military Hospital), Rehabilitation Unit of King goals, require less intensive or active rehabilitation Abdulaziz Medical City, National Guard (Riyadh), or a longer duration of rehabilitation, and required Rehabilitation Hospital of King Fahad Medical City different types of therapy (passive rehabilitation) than (Riyadh), King Saud Medical Complex, Rehabilitation younger people.39 Also, gender is a significant factor Hospital of Al-Hada Military Hospital (Taif) and that must be considered in Muslim societies. There are Riyadh Care Hospital (Private), and Abdulatif Jameel separate rehabilitation facilities for males and females Rehabilitation Center (Jeddah). Additionally, Disabled but there are no statistics or data to justify the number Children Association has 7 centers and provides or distribution of these facilities. Many vocational medical, social, and vocational services for children. rehabilitation trainees are male, while the majority of Moreover, most of MOH hospitals in different regions social rehabilitation intentions on persons with severe of KSA have Medical Rehabilitation Department. Their disabilities or overlapping are females. services are mainly physiotherapy for outpatients. There Over the last 2 decades, the MOH has established is still a greater necessity for more rehabilitation centers several rehabilitative services for persons with due to the following reasons; growing population, disabilities and other residents in the country. Most of increased road traffic accidents with the consequences of these programs offer physical, occupational, speech and traumatic brain injuries, spinal cord injury, amputation hearing therapy as well as prosthetic and orthotic services fractures, and others.39-41 There has been a change in within the existing modern and sophisticated health life style and increased incidence of diabetes mellitus, care service system and infrastructure. Rehabilitation hypertension, ischemic heart disease, and stroke.5 programs and facilities, as an integral part of modern In addition to that, there are an increased number of health care delivery services, have received due attention children born with cerebral palsy or hereditary diseases by government authorities, with services being made because of the consanguinity.39 available to all citizens and residents.35 In KSA, medical rehabilitation has to be advanced Modern medical rehabilitation in KSA started in the as 30% of patients who may be admitted to hospitals early 1960’s following an outbreak of poliomyelitis with are in need of some rehabilitation.39 This would need many victims, mainly children. This resulted in mainly an immediate referral of the patients in need to the paralysis or weakness of the lower extremities. Most of Rehabilitation Medicine services, but as this approach the affected people, who survived, were left with some is going to be new, it may get some non-acceptance by sort of disability largely related to mobility. Because there some of the colleagues in other medical specialty. was no medical rehabilitation department in the few Need of medical rehabilitation hospitals/beds in hospitals present at that time, most of the patients were KSA. As the demographic key indicator of the Saudi sent abroad by the government for surgical correction of census, being a young dominant population, it is

www.smj.org.sa Saudi Med J 2013; Vol. 34 (5) 457 Disability in Saudi Arabia … Al-Jadid estimated the need of medical rehabilitation services Hospital length of stay and quality of life of ranges from 10-30% of total admission to the hospitals. disabled persons. In KSA, very limited research has If we consider a conservative number, and knowing that been conducted on the hospital length of stay (HLOS) in the last cases of MOH, 3,027,575 were admitted and quality of life (QOL) of disabled persons. Recent to the hospitals within KSA, means that at least research reported that the HLOS of traumatic spinal 302,757 needed some medical rehabilitation. However, cord injured patients is 58.8 days and non-traumatic currently, there are approximately 700 beds allocated spinal cord injured patients is 46.2 days.44 The spinal for medical rehabilitation in KSA. Although some cord injury (SCI) in KSA affects mainly the young male patients may have exposure to rehabilitation services population due to road traffic accident (RTA).45 The such as physical therapy or speech language therapy, spinal cord injured patient’s quality of life (QOL) is an estimation of no more than 1% of them received significantly affected and/or hampered by factors such the prober active medical rehabilitation programs. The as accessibility, financial status, and employment.46 medical rehabilitation program could be carried out Previous research reported that stroke in Saudi in a rehabilitation hospitals/specialized rehabilitation population, causes substantial disabilities in an elderly units, outpatients department (visits per service or day population that is cared for mostly by their families. care) or as home health care program. Our estimation Apart from its significant impact on the professional is also that there is a need of at least 30 rehabilitation and social status of the patients, it creates a major load beds/100,000 populations which means at least on their families.47 A significant percentage of elderly, 8000 active rehabilitation beds. It is known that the stroke-related disabilities are expected to afflict tens of current numbers of beds are 20.7/10,000 population thousands in KSA.47 In terms of cost and resources, (207/100,000), which is much below than what the the anticipated burden of this group of disability on government is aiming for and there is a plan to increase society and health services is staggering. In addition, the number by 66,000 beds in the coming 7 years. the hospital costs and length of stay also increase the Rehabilitation should be started as early as possible. burden of the patients’ families and the recent study This could be acute or sub-acute rehabilitation programs reported that the HLOS of Saudi stroke patient is 45 and as inpatients or outpatients. It is estimated that the days.48 Another recent study reported that the pediatric number of rehabilitation beds needed all over KSA neurologic disorders such as cerebral palsy are the to be approximately 8000 beds based on developed common neurologic disorders among Saudi children, countries benchmark. The future can see a wide range which considered as an important reason of long-term of rehabilitation centers whether by the different disability.33 A study reported that the HLOS of pediatric government authorities or through public-private neurologic disorders in KSA is 32.2 days.49 The brain partnership (PPP). This of course would need a good injury also causes substantial disabilities in KSA and the deal of fund by the government. HLOS of traumatic brain injured patients is 58.2 days The legislation of disability and disability code. In and non-traumatic brain injured patients is 43.5 days.51 1987, the legislation of disability (LD) passed as the first Special education services. In 1958, the special legislation for people with disabilities in KSA. The LD education services for disabilities was initiated in contains important provisions that assurance persons KSA when few students with blindness received their with disabilities rights equal to those of other people education in schools known as “scientific institutes”.51 in society.42 In 2000, the disability code was passed The department of special learning to develop learning by the Saudi government to pledge that people with and rehabilitation services for 3 important categories disabilities have access to free and appropriate medical, of students with disabilities: those with blindness, psychological, social, educational, and rehabilitation deafness, and mental retardation were established by services through public agencies.43 The above guiding the Ministry of Education (MOE) during the year of principles support the equal rights of individuals with 1962. Following this, in 1964, 3 institutes were set up disabilities in obtaining free and appropriate education in 3 cities: Makah, Aneaza, and Alhofouf for students and medical facilities. However, these laws were passed with blindness.51 a decade ago and not practiced well in KSA. In fact, the Currently, the MOE provides educational lack of the effective implementation has created in a gap rehabilitation through educational institutions such as between the framework of these laws and the provision the Noor Institute for the Blind, Amal Institute for the of services, resulting in a lack of special education Deaf and the Institute for the Mentally Retarded. Apart services for persons with disabilities. from these special schools, government-owned Social

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Rehabilitation Centers and other institutes for social 8. Gill TM, Kurland BF. Prognostic effect of prior disability welfare provide educational rehabilitation for persons episodes among nondisabled community-living older persons. 35 Am J Epidemiol 2003; 158: 1090-1096. with disabilities in need. Educational programs 9. Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, are also provided for the parents of children with Stock S, et al. Cost-benefit and cost-effectiveness analysis of a disabilities and the majority of these programs are given disability prevention model for back pain management: a six by charitable organizations supported by the Ministry year follow up study. Occup Environ Med 2002; 59: 807-815. 10. Mont D. Measuring disability prevalence. Washington (DC): of Labor and Social Affairs. However, how effective and World Bank; 2007. helpful these educational programs are in minimizing 11. 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First National Study of Disability In Chile. Santiago (Chile): more is needed to improve these services further. National Fund for Disability in Chile; 2005. In conclusion, the review reported that there is a lack 15. Imms C. The International Classification of Functioning, Disability and Health: they’re talking our language. Australian of published research on disability in KSA. However, Occupational Therapy Journal 2006: 53: 65-66. these research are greatly needed to plan for appropriate 16. Lerma RV. Generating disability data in Mexico [Estadística management programs, effective implementation of sobre personas con discapacidad en CentroAmérica]. Managua, primary prevention strategies, and proper allocation of Inter-American Development Bank, 2004. (Updated 2004. Accessed 3 February 2010). Available from URL: http://tinyurl. health resources in this area. com/ylgft9x 17. Jelsma J. Use of the International Classification of Functioning, Acknowledgment. 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